Sean Ianchulev
Analyst · Esther Rajavelu from Oppenheimer. Your question, please
Thank you, Alex and welcome, everyone to Eyenovia's fourth quarter and full-year 2019 earnings conference. 2019 was a successful year for Eyenovia as we continued to validate our patented piezo-print delivery technology. And as we reprioritize our late stage pipeline to focus on high value indication that we believe now represent an approximately $7 billion total market opportunity in the United States for the company. Earlier in the year, we successfully completed our MicroStat Phase III MIST-1 and MIST-2 studies for pharmacologic mydriasis, which have further validated our novel approach to treating front and back of the eye conditions as well as paved the way towards the new drug application submission to the US Food and Drug Administration later this year. Furthermore, the initiation of our MicroPine Phase III study for progressive myopia, represented a significant achievement last year. And we hope to complete patient enrollment by the end of this year, although the impact of the coronavirus pandemic could result in a delay. We were also very excited to introduce our third Phase III program MicroLine for presbyopia as we reprioritized our pipeline to focus on high value indication. We believe our on demand treatment of presbyopia represents tremendous untapped potential and we are working diligently to initiate the Phase III VISION trial in the months ahead, although the trials could also potentially be impacted by COVID-19. As we continue to rapidly advance our late stage program, we were also very pleased to expand our Scientific Advisory Board with the addition of professor Mark Bullimore and April Jasper, both bring a wealth of scientific academic and practical experience in visual sciences and optometry, childhood myopia and presbyopia and we look forward to leveraging their experience as we advance our product candidates to the clinic. Today, I'm going to highlight our success with the Phase III trials for MicroStat, reveal the progress of the rest of our exciting pipeline, and then hand the call over to Michael to discuss our commercial development strategy. But before we begin, I want to take a few moments to discuss how COVID-19 might impact our company. While we source the number of components from Asia, our supply chain for clinical products has built in lead times that we believe are not currently at risk. That said, we also depend on third-party contract vendors as well as clinical and business partners where the expanding impact of the pandemic on the business environment both locally and globally could have an impact on our business. We are closely tracking environment enrollment in our ongoing clinical study, as well as events that must be completed to initiate upcoming clinical studies. Neither of our programs involves patient populations who are at most at risk for the virus, and we're taking steps to help ensure the health of our clinical partners involved in the study by limiting unnecessary travel and the like. But it is possible that patients may be less inclined or unable to participate in our studies if their mobility is limited by shelter in place orders or the clinical science has temporarily scaled down investigational activities. Additionally, on the vendor side, we depend on U.S based sterilization and sterile field partners for our products. And any shut down or backlogs on their end could have an adverse impact on our business and anticipated milestones. Turning now to our product candidate. MicroStat is our first pipeline program to complete Phase III studies in early 2019, which was very exciting for us as it further validated our technology and approach. As a reminder, MicroStat is our novel fix combination formulation of phenylephrine and tropicamide for pharmacologic mydriasis, two products that are often used together during the approximately 18 million diagnostic eye exams and 4 million cataract surgeries performed each year in the United States. During the first quarter of 2019, we were very pleased to report positive results from the MIST-1 and MIST-2 trials demonstrating that MicroStat was safe and effective for pharmacologic mydriasis by achieving clinically and statistically superior mean pupil dilation to both the individual components and placebo. Both studies achieved their primary endpoint with slightly more than 93% of treated eyes achieving pupil dilation of at least 6 millimeter, at 35 minutes post instillation, just shy of two-thirds of patients reached this same endpoint within 20 minutes. And equally importantly, this efficacy was achieved with only one patient report of stinging among the 131 patients tested. The current eye drop formulations of these drugs often cause significant sting, enough so that many doctors will pre-treat with an anesthetic eye drops. With these Phase III trial results in hand, as well as ongoing stability testing of registration laws, we're preparing to file the NDA with the FDA in late 2020. If approved, this would be our first commercial product and we'll begin introducing ophthalmologists, optometrists and patients to the Optejet technology. We believe that this will help prepare the eye care market for our additional products in presbyopia and myopia. One thing I would like to highlight is a design feature of our Optejet dispenser. We purposely designed the dispenser without any protruding part to minimize the chance of cross-contamination of the product by preventing direct contact with the eye. In a recent study, 40% of eye drop users were found to accidentally touch the eye with the bottle tip when instilling drops. Avoiding this potential contamination source may turn out to be a great -- much greater importance than we felt in the past, particularly since practices use the same eyedropper bottles of multiple patients. Before the current situation, the word epidemic had been used to describe what is happening with our children and their eyesight. Around the world, it is estimated that hundreds of millions of children are becoming progressively more myopic. For the last couple of years, Eyenovia has been working to address this crisis. Our Phase III program MicroPine for the treatment of progressive myopia in children is currently enrolling patients in our CHAPERONE trial. MicroPine represents our largest potential market opportunity. The prevalence of myopia has grown at an unprecedented rate over the last few decades, and according to a recent article in the AAO Journal Ophthalmology, by 2030, nearly half of the population in North America and East Asia is expected to be myopic. With our MicroPine program we aim to tackle this epidemic the way it starts in children, and we believe that we could have one of the first potential pharmacologic treatment options for progressive myopia. In 2019, we initiated our Phase III CHAPERONE study, which is a randomized double mask trial set to enroll more than 400 children between 3 and 12 years of age. The study is examining the safety and efficacy of our proprietary atropine topical micro formulation delivered in the Optejet dispenser for the reduction of progressive myopia. Subjects are being randomized to receive treatment with either of two MicroPine concentrations or a placebo, and the primary efficacy endpoint is the change in refractive error from baseline through 36 months. As we continue to enroll patients in our study, we've been able to gather some preliminary data with regards to patients being able to properly administer their medication with the Optejet. After enrolling in the CHAPERONE study, parents and their child who received the short training session and recent instruction on how to use the Optejet. After this session, we found that in every case, either the parent or child was able to successfully use the dispenser at home to reliably deliver a microdose to the eye. And in most cases, the children, some as young as 6, were able to use the dispenser by themselves. This data is really encouraging and further supports our platform technology's potential to vastly improve the way we treat ocular disease with people across all age groups. Before we move on from our myopia program, I wanted to highlight one regulatory pathway for MicroPine. As many people might wonder why are we only conducting a single Phase III study as compared to the typical two. Our Phase III CHAPERONE trial is not the only study that we will be including in our potential NDA. From our discussions with the FDA, the agency has agreed that they will accept data from the previously completed collaborative academic studies that were published over the last few years. And this is not just for our CHAPERONE study, but for all companies and studies looking at progressive myopia. So this is a very consistent stance by the agency. This supplemental studies include ATOM 1, ATOM 2, and LAMP, which were all well controlled, randomized long-term studies that we have discussed in the past. Each of these studies show that atropine can slow the progression of myopia by between 60% and 70%.We plan to leverage the studies alongside our CHAPERONE study in a potential NDA filing, and we believe that the results of this study significantly derisk the CHAPERONE study. Now let's take a look at our newest program, MicroLine for presbyopia, which has garnered significant interest from the optometric community since we reprioritized our pipeline last year. As you may remember, presbyopia is the non preventable age related hardening of the ocular lens, which causes the gradual loss of the eyes ability to focus on nearby objects. Currently, this space is dominated primarily by devices such as the reading glasses and there are no pharmacologic drugs for this indication. In the United States, presbyopia affects an estimated 130 million people. Of that population, we estimate that 43 million people between the ages of 40 and 65, who have otherwise normal vision and available disposable income could benefit from a pharmacologic treatment option like MicroLine. MicroLine is our proprietary microdose array [ph] print formulation of pilocarpine, which has the potential to improve near vision. MicroLine works by constricting the pupil, increasing the depth of field and focus, and making it easier to see up close. MicroLine is designed as a complement to reading glasses. But when patients do not wish to use glasses and together with our Optejet dispenser is designed to provide good tolerability and make installation easy and simple versus traditional eye drops. We believe that with the combination of our proprietary formulation and our microdose platform, we have the opportunity to enhance the lifestyle of millions of people with a cash-pay prescription drug for the improvement of near vision in the model of other esthetic focused products. Looking ahead, we're currently preparing our Phase III VISION 1 and VISION 2 studies and expects to initiate both trials this year. Although the impact of the coronavirus pandemic could result in delay. Subjects will be randomized to receive treatment with either of two MicroLine concentrations or a placebo. And our primary endpoint of the studies will be binocular distance corrected near visual acuity. So now I would like to turn the call over to our VP of Commercial, Michael Rowe, to discuss commercialization activities.